Scabies Worse After Treatment

Don't Despair

Firstly it is important to stress that just because your symptoms are not gone after applying treatment does not mean that the treatment has failed. It is normal for itchiness and bumps to persist for up to a month after treatment however these will progressively diminish and fade as time goes by.

If you applied the treatment and the next day your itch was as intense or worse you should note that this is perfectly normal. The itchiness is caused principally by two things: the movement of the mites and your bodies immune reaction to the mites. Your body is allergic to the mites and the stuff that they leave behind (I bet you can guess what that is). Just because you have killed the mites does not mean that they are gone from your body. After the mites have been killed, your body will still exhibit a reaction to the dead mites and their droppings. It will take time for this to work its way out of your body.

Scabies on Wrist

Scabies typically follow a highly predicable pattern with the writs, between the fingers, between the toes and the groin being extremely common targets for infestation
Scabies typically follow a highly predicable pattern with the writs, between the fingers, between the toes and the groin being extremely common targets for infestation
Scabies often affect the groin which can be intensely itchy but socially awkward to itch.
Scabies often affect the groin which can be intensely itchy but socially awkward to itch.

What Doesn't Work

  • Non-sedating antihistamines are not much use at providing relief from itching. However they do provide relief from some other conditions which are confused with scabies.
  • Natural treatments are unlikely to be particularly helpful as none have been shown to be effective treatments for scabies.

What You Can Do To Make Things Better

There are a number of things you can do to make you feel better while the treatment takes effect.

  • Turn down the shower. You have probably noticed that having a very hot shower makes the itching much worse. Hence turning down the shower makes sense. You should aim for the sweet spot which exactly balances the unpleasantness of the itch with the unpleasantness of a cold shower (a short lukewarm shower is your best bet).
  • Also shower regularly to help get the substances you are allergic to out of your system quicker but don't over do it. There is no need to shower more than twice a day. Excessive showering can cause irritation. It's also best to keep these showers short. Showering is preferable to bathing.
  • If you are having trouble sleeping you may wish to ask your doctor for sedating antihistamine or another sleep aid. For milder cases an over the counter product like Horlicks could help.
  • If the itching continues to be very bad at night consider going to bed very late such that your are very tired and hence may find it easier to fall asleep.
  • Cut your nails to prevent them from doing further damage to your skin. With scabies it is possible to get a secondary infection such as impetigo if you itch too much (i.e. you induce bleeding by itching so much).
  • Wear cotton or silk clothing to minimise skin irritation.
  • In very extreme cases a doctor may prescribe an antidepressant to help you sleep

Permethrin 5% Cream: The most common and effective treatment. This cream is highly effective at treating scabies.
Permethrin 5% Cream: The most common and effective treatment. This cream is highly effective at treating scabies.

How To Prevent Reinfestation

Probably the most common reason for treatment failure is reinfestation. You should take steps to minimise the chances of this. This can be accomplished by following a few simple precautions.

  • Wash all of your clothes, bedding and towels at over 50C. Anything that can't be washed should be sealed away for at least 3 days
  • Household members (especially your partner or other sexual partners or anyone you have prolonged skin contact with) must be treated simultaneously.
  • Apply the treatment (unless directed otherwise) twice with a 7-10 day separation

Treatment Failure

It is possible that your issue is that the treatment has not been successful. There can be a number of reasons for this. If the symptoms persist for six weeks or more following treatment then the treatment can reasonably be considered to have failed. If your scabies is still getting significantly worse over a week after the last application of cream or course of treatment then it is advisable that you speak to your general practitioner or dermatologist again. If you are experiencing bad side effects (see the leaflet that came with your treatment) you should report these.

Before deciding that the diagnosis or treatment prescribed is wrong it is important to consider whether you have applied the treatment exactly as directed. If one mite survives then you are not cured as it is likely that this mite will be sufficient that reinfestation could occur. Hence it is essential that when applying the cream that absolutely every part of the body (usually excluding the face and head unless specifically directed) must be covered by the cream. If you have missed or neglected any areas it is possible that a mite survived and thus the treatment was unsuccessful. Common parts missed include the cleft of the buttocks, the genitals, between the toes and under the fingernails. For this reason, along with other reasons, it is advisable to apply scabies medication twice around one week to ten days apart. However, it is worth noting that treatment with permethrin cream has an effectiveness of around 90% on the first application.

Another reason for treatment failure is that scabies may be an incorrect diagnosis. Certain indicators are highly correlated with scabies such as pimples between the figures and the presence of burrow like structures. Thus if these are present your GP is likely to treat you for scabies and then explore other possibilities only if this treatment does not succeed. The only way to conclusively diagnose scabies is to take a scraping of the skin and view it under the microscope and see a mite, its eggs, opened egg shells or the mites faeces. Your treatment provider will be able to perform a skin scraping to rule out scabies or prove treatment failure. Treatment failure, when the treatment is correctly applied is strong evidence against the presence of scabies.

It is possible that the condition is caused by something else and thus the scabies treatment will have done nothing. If you continue to have severe itching six weeks after correct and dual application of the scabies treatment you should consult your healthcare provider who will explore other possibilities.

Another reason why after a long time has elapsed your symptoms have persisted is reinfestation. You may have succeeded in killing all of the mites but subsequently picked them up again. It is for this reason that it is essential that everyone that you regularly have prolonged skin contact with is treated even if they have no symptoms. If you are treated and your partner is not then you could catch them again. For example you may have infected your partner shortly before treatment (at a type where you had no symptoms) and then they reinfect you without knowing they are infected as an individual who has not been infected may take as long as 6 weeks post initial infection to show symptoms.

Nodular Scabies (Post Scabies Syndrome)

If symptoms persist beyond 6 weeks it is still possible that you did in fact have scabies and the treatment was in principle successful in that the mites are now dead. This is because some people have a hypersensitivity to mites and their leftovers. This causes the immune reaction and the itching to continue beyond what is normally associated with scabies. There is evidence that tacrolimus 0.03% ointment is an effective treatment for this presentation of scabies.

Readers Experiences

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1 comment

2 months ago

I suffered for 6 months but could not find any pathology result with so many different specialist I have been through ... after cleared 5 months now, I have a anxiety symptoms of the mites as I still dont know what was small tiny black dots were coming out after i put cream on.

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